P370. Using Ascending-to-Descending Aortic Bypass to Manage Stent Graft Infection By A Rare Pathogen After Thoracic Endovascular Aortic Repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Department of Medical Education, Chang Gung Memorial Hospital
Taoyuan City, NA
Taiwan - Contact Me
Tsung-Han Cheng is an aspiring last year medical school student from Chang Gung University and Chang Gung Memorial Hospital in Linkou, Taiwan. His clinical and research interests revolve around surgical outcomes and health economics within the field of cardiovascular interventions.
Before medical school, he completed his undergraduate studies at National Taiwan University (NTU), obtaining a degree in finance.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective:
Stent graft infection (SGI) caused by a pathogen Burkholderia cepacia complex is rare. Its subsequent clinical course and surgical management are therefore of clinical value to future similar encounters, especially in multiple traumatic thoracic intervention cases.
Methods:
This investigation was conducted by reviewing the patient's clinical course and management. The patient's laboratory tests and imaging studies were presented alongside its clinical course, followed by the final reconstructed three-dimensional image showing the final vascular reconstruction result.
Results:
A 41-year-old man with a history of falling injury had multiple surgical interventions for left lung contusion and hemopneumothorax, right lung pneumothorax, traumatic aortic injury (TAI) grade III (pseudoaneurysm) without evidence of dissection or extravasation in computed tomography angiography, 1st to 12th rib fracture, left clavicle fracture, grade I liver laceration on left liver, right pubic ramus fracture, right sacral ala fracture, left iliac wing fracture, right L5 transverse process fracture, left facial bone, skull and skull base fracture, and left orbital wall fracture. This time, he was admitted due to hemoptysis. Chest CT and positron emission tomography–computed tomography (PET-CT) scan showed a ruptured pseudoaneurysm with a positive signal in the aortic stent graft and periaortic region. Blood culture showed positive finding of B. cepacia complex. Thoracic endovascular aortic repair (TEVAR) was performed, accompanied by ceftriaxone and vancomycin for six weeks, ertapenem and daptomycin for two weeks, and daptomycin and meropenem for four weeks. He was afebrile throughout this hospitalisation and his level of serum CRP was managed to less than 5 in the last week. The patient was then discharged with routine follow-up and an 8-day course of oral linezolid and levofloxacin. However, the patient's positive findings of B. cepacia complex bacteremia 4 months later and positive signal in PET-CT supported persistent infected aortic aneurysm and SGI. This prompted the surgical team to perform the following operation under cardiopulmonary bypass and cardioplegia: 1. The infected aorta from zone I to T8 and stent graft were removed. 2. Ascending-to-descending aortic bypass (ADAB) was performed with an 18-mm graft end-to-side anastomosed to the ascending aorta. The graft extended caudally, passed next to the right atrium, traversed between the right ventricle and the diaphragm, posteriorly passed through the posterior pericardium, and finally anastomosed to the thoracic descending aorta. 3. The left carotid artery was debranched with an 8-mm graft and anastomosed to the 18-mm graft. Finally, negative findings in the follow-up blood culture and diminished PET-CT signals achieved and clinical symptoms and signs improved. The patient was therefore discharged and recovered with no complications in the follow-up.
Conclusions:
This is the first case showing a patient with SGI caused by B. cepacia complex managed successfully through ADAB.
Authors
Shao-Wei Chen (1), Tsung-Han Cheng (2), Yu-Ting Cheng (3), Sung-Yu Chu (4), Chih-Chun Lee (5), Shao-Wei Chen (1)
Institutions
(1) Chang Gung Memorial Hospital, Linkou, Taoyuan, taiwan, (2) Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan City, NA, (3) Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City, NA, (4) Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, NA, (5) Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan City, NA
Stent graft infection (SGI) caused by a pathogen Burkholderia cepacia complex is rare. Its subsequent clinical course and surgical management are therefore of clinical value to future similar encounters, especially in multiple traumatic thoracic intervention cases.
Methods:
This investigation was conducted by reviewing the patient's clinical course and management. The patient's laboratory tests and imaging studies were presented alongside its clinical course, followed by the final reconstructed three-dimensional image showing the final vascular reconstruction result.
Results:
A 41-year-old man with a history of falling injury had multiple surgical interventions for left lung contusion and hemopneumothorax, right lung pneumothorax, traumatic aortic injury (TAI) grade III (pseudoaneurysm) without evidence of dissection or extravasation in computed tomography angiography, 1st to 12th rib fracture, left clavicle fracture, grade I liver laceration on left liver, right pubic ramus fracture, right sacral ala fracture, left iliac wing fracture, right L5 transverse process fracture, left facial bone, skull and skull base fracture, and left orbital wall fracture. This time, he was admitted due to hemoptysis. Chest CT and positron emission tomography–computed tomography (PET-CT) scan showed a ruptured pseudoaneurysm with a positive signal in the aortic stent graft and periaortic region. Blood culture showed positive finding of B. cepacia complex. Thoracic endovascular aortic repair (TEVAR) was performed, accompanied by ceftriaxone and vancomycin for six weeks, ertapenem and daptomycin for two weeks, and daptomycin and meropenem for four weeks. He was afebrile throughout this hospitalisation and his level of serum CRP was managed to less than 5 in the last week. The patient was then discharged with routine follow-up and an 8-day course of oral linezolid and levofloxacin. However, the patient's positive findings of B. cepacia complex bacteremia 4 months later and positive signal in PET-CT supported persistent infected aortic aneurysm and SGI. This prompted the surgical team to perform the following operation under cardiopulmonary bypass and cardioplegia: 1. The infected aorta from zone I to T8 and stent graft were removed. 2. Ascending-to-descending aortic bypass (ADAB) was performed with an 18-mm graft end-to-side anastomosed to the ascending aorta. The graft extended caudally, passed next to the right atrium, traversed between the right ventricle and the diaphragm, posteriorly passed through the posterior pericardium, and finally anastomosed to the thoracic descending aorta. 3. The left carotid artery was debranched with an 8-mm graft and anastomosed to the 18-mm graft. Finally, negative findings in the follow-up blood culture and diminished PET-CT signals achieved and clinical symptoms and signs improved. The patient was therefore discharged and recovered with no complications in the follow-up.
Conclusions:
This is the first case showing a patient with SGI caused by B. cepacia complex managed successfully through ADAB.
Authors
Shao-Wei Chen (1), Tsung-Han Cheng (2), Yu-Ting Cheng (3), Sung-Yu Chu (4), Chih-Chun Lee (5), Shao-Wei Chen (1)
Institutions
(1) Chang Gung Memorial Hospital, Linkou, Taoyuan, taiwan, (2) Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan City, NA, (3) Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City, NA, (4) Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, NA, (5) Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taoyuan City, NA
Presentation Duration
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